Abstract
Objectives
To validate a newly developed multiple symptom self-assessment tool in nursing homes.
Design
Thirty prevalent symptoms identified in the literature were classified by a 2-round
Delphi procedure to a top 10 of the most relevant, burdensome symptoms. Because no
existing symptom scale fully covered this top 10, we developed a new scale, consisting
of a horizontal numerical scale for the top 10 symptoms, with the possibility to add
and rate 3 other symptoms. This scale was validated.
Setting and participants
Hundred seventy-four participants, mean age 85 (±5.94) years, were recruited from
7 nursing homes (86%) and 3 acute geriatric wards (14%).
Methods
To test the construct validity, participants with and without a palliative status
were enrolled. Participants completed the Symptom Assessment to Improve Symptom Control
for Institutionalized Elderly (SATISFIE) scale on day 0 and day 1 (intrarater reliability).
Nurses completed the scale on day 0 (inter-rater reliability). Descriptive statistics
described the characteristics of the study population and symptom scores. Differences
in symptom scores between palliative and nonpalliative participants were analyzed
with the Mann-Whitney U test. Intrarater and inter-rater reliability were calculated
by means of an intraclass correlation coefficient. Factor analysis searched for possible
symptom clusters. Feasibility was evaluated by measuring the assessment time and by
providing a questionnaire for the nurses.
Results
In the nonpalliative group (n = 130), the highest self-rated median scores were pain
on day 1 [median 3, interquartile range (IQR) 0–5] and pain on day 2. In the palliative
group (n = 44), the highest median self-rated scores were fatigue on day 1 [median
5 (IQR 0–6)], lack of energy on day 1 and 2 [both median 5 (IQR 0–8)]; and depressed
feeling on day 2 [median 3 (IQR 0–5)]. Nurse assessments median scores were the highest
for depressed feeling [median 5 (IQR 1–7)], fatigue [median 4.5 (IQR 0–6.5)], and
lack of energy, [median 3 (IQR 0–6)] in the palliative group. In the nonpalliative
group, none of the median scores was 3 or more. Intraclass correlation coefficients
for intrarater reliability varied between 0.65 and 0.89 and for inter-rater reliability
(patients-nurses) between 0.18 and 0.63. Mean assessment time for nurses was 2.0 minutes
[standard deviation (SD) = 1.01]. For participants, it decreased from 10.5 minutes
(SD = 5.41) at the first assessment to 7.5 minutes (SD = 3.72) at the second assessment.
Nurses determined the SATISFIE instrument to be useful, applicable in daily practice,
and sufficiently comprehensible for the patients.
Conclusions
The SATISFIE scale is a valid and feasible instrument for regular, multiple symptom
assessment in institutionalized older persons.
Keywords
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Article info
Publication history
Published online: October 14, 2017
Footnotes
The PhD trajectory of Marc Tanghe is funded by the “PACE” project of the EU (Framework Program 7 Grant Agreement 603111).
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
